The Transtheoretical Model

EVIDENCE-BASED BEHAVIOR CHANGE

Pro-Change programs are grounded in the proven effective
Transtheoretical Model of Behavior Change (TTM), sometimes called the
Stages of Change.

Change is a process, not an event. The TTM groups the change process
into distinct stages of readiness, and provides approaches to help move
people forward through the stages.

People in the earliest stage are not intending to make a behavior change
(Precontemplation). They may not even be aware that their behavior is
unhealthy or they may be demoralized from past failed attempts. People
in the final stage have made a change and are working to keep it up
(Maintenance). And in the middle—we have some who are just starting to
think about changing their behavior (Contemplation), others who have
decided to make a behavior change (Preparation), and still others who
have just begun to take action to change their behavior (Action).

Research has shown that up to 80% of people are not ready to go to

action right away. It’s something they have to work up to, and not
everyone moves at the same pace. People can resist pressure to take
action if they are not ready for it.

Our programs are effective because at each step they deliver

individualized guidance that reflect each participant’s view of a particular
behavior and readiness to change. At each stage they receive expert
feedback on which processes and principles of change they are applying
appropriately, which they are overutilizing and underutilizing, and specific
steps they can take to progress to the next stage. A single behavior
program can provide many thousands of possible interactions over time.

MORE ABOUT THE TRANSTHEORETICAL MODEL

The TTM:

 uses the Stages of Change to integrate the most powerful processes and
principles of change from leading theories of counseling and behavior
change;
 is based on principles developed from over 35 years of scientific research,
intervention development, and scores of empirical studies;
 applies the results of research funded by over $80 million worth of grants and
conducted with over 125,000 research participants; and
  is currently in use by professionals around the world.

STAGES OF CHANGE OVERVIEW

Stage 1: Precontemplation (Not Ready)

Participants at this stage do not intend to start the healthy behavior in

the near future (within 6 months), and may be unaware of the need to
change.

Participants here learn more about healthy behavior: they are encouraged
to think about the Pros of changing their behavior and to feel emotions
about the effects of their negative behavior on others.

Precontemplators typically underestimate the Pros of changing,

overestimate the Cons, and often are not aware of making such mistakes.
These individuals are encouraged to become more mindful of their
decision making and more conscious of the multiple benefits of changing
an unhealthy behavior.

Stage 2: Contemplation (Getting Ready)

At this stage, participants are intending to start the healthy behavior

within the next 6 months. While they are usually now more aware of the
Pros of changing, their Cons are about equal to their Pros. This
ambivalence about changing can cause them to keep putting off taking
action.

Participants here learn about the kind of person they could be if they
changed their behavior and learn more from people who behave in
healthy ways. They’re encouraged to work at reducing the Cons of
changing their behavior.

Stage 3: Preparation (Ready)

Participants at this stage are ready to start taking action within the next
30 days. They take small steps that they believe can help them make the
healthy behavior a part of their lives. For example, they tell their friends
and family that they want to change their behavior.

During this stage, participants are encouraged to seek support from

friends they trust, tell people about their plan to change the way they act,
and think about how they would feel if they behaved in a healthier way.
Their number one concern is—when they act, will they fail? They learn
that the better prepared they are the more likely they are to keep
progressing.

Stage 4: Action

Participants at this stage have changed their behavior within the last 6
months, and need to work hard to keep moving ahead. These participants
need to learn how to strengthen their commitments to change and to
fight urges to slip back.

Strategies taught here include substituting activities related to the

unhealthy behavior with positive ones, rewarding themselves for taking
steps toward changing, and avoiding people and situations that tempt
them to behave in unhealthy ways.

Stage 5: Maintenance

Participants at this stage changed their behavior more than 6 months

ago. It is important for people in this stage to be aware of situations that
may tempt them to slip back into doing the unhealthy behavior—
particularly stressful situations.

Participants here learn to seek support from and talk with people they
trust, spend time with people who behave in healthy ways, and remember
to engage in alternative activities to cope with stress instead of relying on
unhealthy behavior.

HOW DO PEOPLE MOVE FROM ONE STAGE TO ANOTHER?

 The Transtheoretical Model

In general, for people to progress they need:

A. A growing awareness that the advantages (the “Pros”) of changing outweigh

the disadvantages (the “Cons”)—the TTM calls this decisional balance
B. Confidence that they can make and maintain changes in situations that tempt
them to return to their old, unhealthy behavior—the TTM calls thisself-efficacy
C. Strategies that can help them make and maintain change—the TTM calls
these processes of change. The ten processes include:
1. Consciousness Raising—increasing awareness via information, education, and
personal feedback about the healthy behavior.
2. Dramatic Relief—feeling fear, anxiety, or worry because of the unhealthy behavior,
or feeling inspiration and hope when they hear about how people are able to
change to healthy behaviors
3. Self-Reevaluation—realizing that the healthy behavior is an important part of who
they are and want to be
4. Environmental Reevaluation—realizing how their unhealthy behavior affects others
and how they could have more positive effects by changing
5. Social Liberation—realizing that society is more supportive of the healthy behavior
6. Self-Liberation—believing in one’s ability to change and making commitments to
act on that belief
7. Helping Relationships—finding people who are supportive of their change
8. Counter Conditioning—substituting healthy ways of acting and thinking for
unhealthy ways
9. Reinforcement Management—increasing the rewards that come from positive
behavior and reducing those that come from negative behavior
10. Stimulus Control—using reminders and cues that encourage healthy behavior.
Different strategies are most effective at different Stages of Change. For
example, Counter Conditioning and Stimulus Control can really help
people in the Action and Maintenance stages. But these processes are not
helpful for someone who is not intending to take action. Consciousness
Raising and Dramatic Relief work better for someone in this stage
(Precontemplation). That’s why Pro-Change programs tailor feedback to
each individual in stage-matched interventions.